Non-traumatic splenic rupture – A rare first presentation of Malaria

Abstract text (incl. references and figure legends)

Introduction:

It is important for physicians to know the clinical course of malaria, since it is an uncommon disease in developed countries but travelers can also be exposed. The spleen can harbour parasites that can cause recurrent infection, leading to splenomegaly and rupture of the spleen.

During the course of severe malaria, spontaneous rupture of the spleen is a rare but potentially life-threatening complication. There is no doubt that being aware is of utmost importance, since a delayed or missed diagnosis can have fatal consequences for the patient.

Most of the splenic ruptures have been associated with Plasmodium vivax; however, on rare occasions, other Plasmodium infections have also resulted in the rupture of the spleen.

Results:

We report a case of a 45 years old male, who traveled from Angola to Portugal, that went to the Emergency room with generalized abdominal pain, predominantly epigastric, fever and purulent cough, with 76/54mmHg blood pressure and a heart rate of 115 bpm.

Blood tests revealed: Hemoglobin 11,9 g/dL; P. falciparum 5%; platelets 35000/uL; Type 1 respiratory insufficiency; Lactats 2,9 mmol/L.

CT scan showed signs of splenic rupture, with a volumous perisplenic hematoma, with blush, and a moderate volume hemoperitoneum.

An angiography was performed and showed no active hemorraghy.

It was then admitted to an ICU unit to perform vigilance.

After 2 days, the Hb went to 8,3 g/dL and become stable after.

It was discharged 16 days later, asymptomatic with Hb 8,9 g/dL.

Conclusion:

Spontaneous splenic hemorrhage is a rare complication of infectious diseases in western world. Due to the life threatning complications, the clinician should be aware of the pathology to rapidly diagnose and treat. In this particular case, a conservative treatment was successful in a severe case of malaria.

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